WHA members can self-refer for behavioral health (BH) services as long as they contact a BH provider first and obtain prior authorization. Providers can refer on a patient’s behalf and speak directly with a BH professional 24/7 if your patient or a parent is unable or reluctant to seek BH services themselves or needs assistance in knowing what to do next. 

Most WHA members have Magellan/HAI-CA as their BH provider organization. Call 800-424-1778, then select the emergency choice to speak directly to a clinician. 

Depression is a common illness, and even those with the most severe depression can get better with treatment, usually medication and/or psychotherapy. Proper depression screening and evaluation are essential prior to prescribing an antidepressant. It’s important to identify co-existing alcohol/substance abuse issues or serious medical conditions such as heart disease, diabetes, cancer, etc. Treating the depression can also improve the outcome of treating the co-condition.

WHA’s performance measurement for Antidepressant Medication Management is focused on continued medication therapy. WHA annually measures effectiveness with the HEDIS measure, “Antidepressant Medication Management,” which determines the percentage of members 18 years of age and older with a diagnosis of major depression who were newly treated with antidepressant medication, and who remained on an antidepressant medication treatment. This measure allows for some gaps in medication treatment. This can include wash-out period gaps to change medication or treatment gaps to refill the same medication. There are two rates reported:

• Effective Acute Phase Treatment (12 weeks): The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days during the first 114-day period following the prescription start date. This phase allows for treatment gaps of up to a total of 30 days.
• Effective Continuation Phase Treatment (6 months): The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 180 days during the 231-day period following the prescription start date. This phase allows for treatment gaps of up to a total of 51 days.

Barriers frequently noted in the acute phase of therapy are issues underlying the patient’s medication adherence: intolerance of side effects or unmet expectations of feeling better early in therapy. Timely follow-up visits and/or telephonic outreach to re-evaluate the patient and the antidepressant therapy are essential. Most screening for depression and initiation of treatment occurs in primary care. Referral to a behavioral health specialist is an option, particularly for patients with increasing symptoms or difficulties with medication adherence.